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      Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS)

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          Abstract

          Objective: to examine the clinical evidence reporting the prevalence of sarcopenia and the effect of nutrition and exercise interventions from studies using the consensus definition of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).

          Methods: PubMed and Dialog databases were searched (January 2000–October 2013) using pre-defined search terms. Prevalence studies and intervention studies investigating muscle mass plus strength or function outcome measures using the EWGSOP definition of sarcopenia, in well-defined populations of adults aged ≥50 years were selected.

          Results: prevalence of sarcopenia was, with regional and age-related variations, 1–29% in community-dwelling populations, 14–33% in long-term care populations and 10% in the only acute hospital-care population examined. Moderate quality evidence suggests that exercise interventions improve muscle strength and physical performance. The results of nutrition interventions are equivocal due to the low number of studies and heterogeneous study design. Essential amino acid (EAA) supplements, including ∼2.5 g of leucine, and β-hydroxy β-methylbutyric acid (HMB) supplements, show some effects in improving muscle mass and function parameters. Protein supplements have not shown consistent benefits on muscle mass and function.

          Conclusion: prevalence of sarcopenia is substantial in most geriatric settings. Well-designed, standardised studies evaluating exercise or nutrition interventions are needed before treatment guidelines can be developed. Physicians should screen for sarcopenia in both community and geriatric settings, with diagnosis based on muscle mass and function. Supervised resistance exercise is recommended for individuals with sarcopenia. EAA (with leucine) and HMB may improve muscle outcomes.

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          Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: a randomized controlled trial.

          Considerable evidence suggests that the loss of strength and muscle mass appear to be inevitable consequences of aging. Moreover, aging is associated with an increase in body fat. This study examined whether increased physical activity could prevent or reverse the losses of strength and skeletal muscle mass as well as the gain in fat in older adults. Eleven men and 31 women completed a randomized trial consisting of either a physical activity (PA; n = 22) or successful aging health educational control (SA; n = 20) group. Isokinetic knee extensor strength and computed tomography-derived midthigh skeletal muscle and adipose tissue cross-sectional areas (CSA) were assessed at baseline and at 12 mo following randomization. Total body weight and muscle CSA decreased in both groups, but these losses were not different between groups. Strength adjusted for muscle mass decreased (-20.1 +/- 9.3%, P < 0.05) in SA. The loss of strength was completely prevented in PA (+2.5 +/- 8.3%). In addition, there was a significant increase (18.4 +/- 6.0%) in muscle fat infiltration in SA, but this gain was nearly completely prevented in PA (2.3 +/- 5.7%). In conclusion, regular physical activity prevents both the age-associated loss of muscle strength and increase in muscle fat infiltration in older adults with moderate functional limitations.
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            Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm.

            Muscle impairment is a common condition in older people and a powerful risk factor for disability and mortality. The aim of this study was to apply the European Working Group on Sarcopenia in Older People criteria to estimate the prevalence and investigate the clinical correlates of sarcopenia, in a sample of Italian community-dwelling older people. Cross-sectional analysis of 730 participants (74% aged 65 years and older) enrolled in the InCHIANTI study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria using bioimpedance analysis for muscle mass assessment. Logistic regression analysis was used to identify the factors independently associated with sarcopenia. Sarcopenia defined by the European Working Group on Sarcopenia in Older People criteria increased steeply with age (p < .001), with 31.6% of women and 17.4% of men aged 80 years or older being affected by this condition. Higher education (odds ratio: 0.85; 95% CI: 0.74-0.98), lower insulin-like growth factor I (lowest vs highest tertile, odds ratio: 3.89; 95% CI: 1.03-14.1), and low bioavailable testosterone (odds ratio: 2.67; 95% CI: 1.31-5.44) were independently associated with the likelihood of being sarcopenic. Nutritional intake, physical activity, and level of comorbidity were not associated with sarcopenia. Sarcopenia identified by the European Working Group on Sarcopenia in Older People criteria is a relatively common condition in Italian octogenarians, and its prevalence increases with aging. Correlates of sarcopenia identified in this study might suggest new approaches for prevention and treatment of sarcopenia.
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              Effect of β-hydroxy-β-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults.

              Loss of muscle mass due to prolonged bed rest decreases functional capacity and increases hospital morbidity and mortality in older adults. To determine if HMB, a leucine metabolite, is capable of attenuating muscle decline in healthy older adults during complete bed rest. A randomized, controlled, double-blinded, parallel-group design study was carried out in 24 healthy (SPPB ≥ 9) older adult subjects (20 women, 4 men), confined to complete bed rest for ten days, followed by resistance training rehabilitation for eight weeks. Subjects in the experimental group were treated with HMB (calcium salt, 1.5 g twice daily - total 3 g/day). Control subjects were treated with an inactive placebo powder. Treatments were provided starting 5 days prior to bed rest till the end rehabilitation phase. DXA was used to measure body composition. Nineteen eligible older adults (BMI: 21-33; age: 60-76 year) were evaluable at the end of the bed rest period (Control n = 8; Ca-HMB n = 11). Bed rest caused a significant decrease in total lean body mass (LBM) (2.05 ± 0.66 kg; p = 0.02, paired t-test) in the Control group. With the exclusion of one subject, treatment with HMB prevented the decline in LBM over bed rest -0.17 ± 0.19 kg; p = 0.23, paired t-test). There was a statistically significant difference between treatment groups for change in LBM over bed rest (p = 0.02, ANOVA). Sub-analysis on female subjects (Control = 7, HMB = 8) also revealed a significant difference in change in LBM over bed rest between treatment groups (p = 0.04, ANOVA). However, differences in function parameters could not be observed, probably due to the sample size of the study. In healthy older adults, HMB supplementation preserves muscle mass during 10 days of bed rest. These results need to be confirmed in a larger trial. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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                Author and article information

                Journal
                Age Ageing
                Age Ageing
                ageing
                ageing
                Age and Ageing
                Oxford University Press
                0002-0729
                1468-2834
                November 2014
                21 September 2014
                21 September 2014
                : 43
                : 6
                : 748-759
                Affiliations
                [1 ]Servicio de Geriatría, Hospital Universitario Ramón y Cajal , Ctra. Colmenar km 9, 1, 28034 Madrid, Spain
                [2 ]Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore , Rome, Italy
                [3 ]Gastroentérologie et Nutrition Clinique, CHU de Nice, Université de Nice Sophia-Antipolis , Nice, France
                [4 ]Universidad Autonoma de Baja California , Tijuana Baja California Mexico, Mexico
                [5 ]Department of Human Health Sciences, Kyoto University, Graduate School of Medicine , Kyoto, Japan
                [6 ]Unité de Nutrition Humaine, UMR 1019, INRA, Université Clermont-Ferrand , CHU de Clermont-Ferrand, France
                [7 ]Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan
                [8 ]Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center on Aging at Tufts University , Boston, MA, USA
                [9 ]Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust , London, UK
                [10 ]Département de Réhabilitation et Gériatrie, Hôpitaux Universitaires de Genève-Suisse , Geneva, Switzerland
                [11 ]Institut for Biomedicine of Ageing, University Erlangen-Nürnberg , Erlangen, Germany
                [12 ]Institute for Exercise Physiology and Wellness Research, University of Central Florida , Orlando, FL, USA
                [13 ]Division of Geriatric Medicine, University of Pittsburgh , Pittsburgh, PA, USA
                [14 ]Department of Geriatric Medicine, Inserm U558 Le Centre Hospitalier Universitaire de Toulouse (CHU) – Gérontopôle , Toulouse, France
                [15 ]Department of Medicine and Therapeutics, Prince of Wales, Hospital, Chinese University of Hong Kong , Hong Kong SAR, The People's Republic of China
                [16 ]Division of Geriatrics, Department of Medicine, University of Verona, Verona, Italy
                [17 ]Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University , Uppsala, Sweden
                Author notes
                Address correspondence to: A. J. Cruz-Jentoft. Tel: +34 913368172, Email: ajcruzjentoft@ 123456telefonica.net
                Article
                afu115
                10.1093/ageing/afu115
                4204661
                25241753
                4a112714-d806-4bd7-937d-8192ee5d3e48
                © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited

                History
                : 22 January 2014
                : 25 June 2014
                Categories
                Systematic Reviews

                Geriatric medicine
                exercise intervention,nutrition intervention,prevalence,age-related,sarcopenia,older people

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